Methods: Nationwide multicenter VAI surveillance system was established in 2008, using the CDC’s NHSN system. Targeted population was patients on hemodialysis due to end-stage renal disease. Incidence of VAI was calculated by the number of infection per 1,000 dialysis sessions. Data collected until December 2014 was analyzed.
Results: The overall incidence of VAI throughout the period differed greatly by the type of access; 0.07 (87 VAI in 1,230,486 dialysis sessions) for arteriovenous (AV) fistula, 0.22 (12/54,324) for superficialization of brachial artery (SBA), 0.70 (41/58,248) for AV graft, 1.04 (32/30,759) for cuffed catheter, and 11.4 (244/21,364) for non-cuffed catheter. Non-cuffed catheter had significantly higher risk for infection than any other type of access. There was a decreasing trend over time in the incidence of all type of access except SBA. Non-cuffed catheter at the femoral site had 1.8 times (95%CI: 1.26-2.67) higher risk of VAI compared to that inserted at the internal jugular site. Patients with diabetes had significantly higher risk of catheter-associated VAI than non-diabetic patients (RR 2.47, 95%CI: 1.74-3.52).
Conclusion: The risk of VAI varied among different types of VA. Non-cuffed catheter had extremely higher risk, therefore its use should be avoided. If its use is inevitable, it should be inserted at the internal jugular site rather than femoral site. Intensified infection control practices should be applied to diabetic patients with the catheter, because they had higher risk of VAI.
K. Morikane, None